Disorders of Red and White Blood Cells

Module details

Title

Disorders of Red and White Blood Cells

Type

Specialist

Module code

SLS124

Credits

10

Requirement

Compulsory

Aim of this module

These modules provide the trainee with the knowledge that underpins the specialist module in Haematology and Transfusion Science and provides trainees with the knowledge and understanding that underpins and is applied to work-based learning.

This module will provide the trainee with the knowledge and understanding of the pathophysiology and clinical presentation of a range of disorders associated with abnormalities of red cell, white cell and haemostatic parameters. In the work-based module they will be expected to apply this knowledge as they perform methods related to red cell, white cell and haemostatic function and gain experience of the interpretation of patient results in a variety of clinical settings.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1,5	Competency Perform methods for the investigation of anaemia including the following: iron deficiency anaemia anaemia of inflammation megaloblastic anaemia hereditary haemolytic anaemias acquired haemolytic anaemias.	Action View
# 2	Learning outcome 1,5	Competency Perform methods for the investigation of a range of hereditary red cell disorders, including the following: sickle cell disease (SCD) thalassaemias other haemoglobin variants red cell enzymopathies red cell membrane defects.	Action View
# 3	Learning outcome 2,5	Competency Perform methods for the investigation of non-malignant white cell disorders including: automated quantitation of white cells, including white cell differential blood film morphology infectious mononucleosis screen.	Action View
# 4	Learning outcome 3	Competency Interpret haematology data in light of clinical details and authorise reports under supervision of patients with anaemia, including: iron deficiency anaemia anaemia of inflammation megaloblastic anaemia hereditary haemolytic anaemias acquired haemolytic anaemias.	Action View
# 5	Learning outcome 3	Competency Interpret haematology data in light of clinical details and authorise reports under supervision of patients with a range of hereditary red cell disorders, including the following: SCD thalassaemias other haemoglobin variants, red cell enzymopathies red cell membrane defects.	Action View
# 6	Learning outcome 3	Competency Interpret laboratory data and reports from the national screening programme for SCD and thalassaemia.	Action View
# 7	Learning outcome 4	Competency Interpret haematology data in light of clinical details and authorise reports under supervision on patients with at least one of the following of white cell disorders: lymphopenia neutropenia leucocytosis	Action View
# 8	Learning outcome 3,4	Competency Identify cases requiring urgent intervention and be able to offer suggest clinical advice on follow-up and/or further management.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Authorise test report for patients with Lymphocytopenia	DOPS
Authorise reports for patients with Neutropenia	DOPS
Authorise test reports reports for patients with Leucocytosis	DOPS
Authorise reports patients with platelet disorders including at least one of the following Congenital disorders Thrombocytopenia Myeloproliferative disorders rugs eg aspirin	DOPS
Perform investigation of Blood film morphology, Infectious mononucleosis screen	DOPS
Authorise reports under supervision on patients with a range of anaemias	DOPS
Authorise written reports under supervision on patients with a range of hereditary red cell disorders	DOPS
Attend a haematology outpatient clinic and take a patient history	OCE
Attend an out patient clinic and take a patient history from a patient with a red cell disorder	OCE
Attend an out patient clinic and take a patient history from a patient with a red cell disorder	OCE

Learning outcomes

1. Perform a range of laboratory and molecular techniques used in the workplace investigate anaemia, red cell disorders.
2. Perform a range of laboratory and molecular techniques used in the workplace to investigate white cell disorders.
3. Identify appropriate clinical and laboratory investigations and outline the management of acquired and hereditary red cell disorders.
4. Identify appropriate clinical and laboratory investigations and outline the management of non-malignant white cell disorders.
5. Perform quality assurance and control tasks across the range of investigations associated with the investigation of red and white blood cell disorders.

Learning outcomes

1. Describe common dietary and acquired anaemias and hereditary red cell disorders.
2. Explain the molecular basis, presentation, diagnosis and management of haemoglobinopathies and thalassaemia.
3. Discuss and evaluate the principles and practice of the national screening programme for sickle cell disease and thalassaemia.
4. Discuss the diversity, investigation, diagnosis and clinical relevance of hereditary red cell disorders.
5. Explain the basis, investigation, diagnosis and clinical relevance of white cell disorders.
6. Describe primary and secondary haemostasis and control mechanisms in haemostasis.
7. Explain the factors that affect the sensitivity and specificity of tests of haemostasis.
8. Discuss the partnership of clinical haematology to other clinical specialisms in the investigation of haematological disorders and patient care.

Indicative content

Have the knowledge and understanding of physiology and pathophysiology, its investigation and diagnosis as it applies to the specialism in the following

Red cells

• Normal physiology and bone marrow production of red cells
• Structure and synthesis of normal and abnormal haemoglobin
• Classification of anaemias
• Iron metabolism and effect of iron deficiency and overload on erythropoesis
• Vitamin B12 and folate metabolism and effect of deficiency on erythropoesis
• Hereditary and acquired haemolytic anaemia
• Principles, scientific basis, range and selection of analytical procedures applied in the investigation of anaemia
• Presentation and laboratory investigation of anaemia, including iron deficiency, megaloblastic, haemolytic and enzymeopathies
• Clinical interpretation of diagnostic results, treatment strategies and management
• Molecular basis of abnormal haemoglobins and thalassaemia syndromes
• The national screening programme for sickle cell disease and thalassaemia
• Phenotypic and genotypic laboratory methods
• Diagnosis of red cell enzymopathies
• IQC and EQA in red cell disorders
• Abnormalities in adults and children
  • Clinical complications of red cell enzymopathies and haemoglobinopathies
  • British Committee for Standards in Haematology (BCSH) Guidelines relevant to red cell investigation

White cells

• Normal leucopoeisis
• Normal structure and function of white cells
• Granulocytes, monocytes and their benign disorders
• Disorders of neutrophil and monocyte function
• Causes of leukocytosis, monocytosis and neutropenia
• Principles, scientific basis, range and selection of analytical procedures applied to the investigation of white cell disorders
• Presentation and laboratory investigation of white cell disorders
• Clinical interpretation of diagnostic results, treatment strategies and management
• BCSH Guidelines relevant to these white cell disorders

Haemostasis

• Primary haemostasis, role in supporting normal haemostasis, including blood vessel structure and function; platelet structure and function
• Role of von Willebrand factor (VWF) in the interaction between blood vessels and platelets
• Secondary haemostasis, including coagulation factors, structure and function, feedback and control mechanisms, localisation of clot
• Vitamin K metabolism in the synthesis of functioning coagulation factors
• Cell-based models of haemostasis and the role of tissue factor
• Natural inhibitors of coagulation
• Fibrinolysis, including activation, inhibition and the breakdown mechanism, fibrin clearance and degradation products
• Use and monitoring of anticoagulant therapyBCSH Guidelines relevant to haemostasis

Activities

• Attend a haematology outpatients’ clinic to gain experience of the patient–consultant interaction and write a reflective report to include key points concerning the patient experience and service delivery.
• Attend ward rounds and/or clinics at which patients are being investigated and treated for haematological disorders. Follow the investigation and diagnosis of at least one patient and discuss the process, outcomes and role of laboratory investigations in the diagnosis, treatment and management of patients.
• Participate in multidisciplinary review meetings at which haematology results are presented as part of the clinical record in patients with haematological disorders. Reflect and report on the importance of a multidisciplinary approach to the diagnosis, treatment and management of patients.
• Prepare a portfolio of relevant cases, including learning points and clinical outcomes including key learning points for your own future practice.
• Observe family counselling and report on your experience, including perceptions of the importance of this approach, the effectiveness of the process and the potential outcomes for the patient and their family.
• Critically appraise the findings of a review of the internal quality control and external quality assessment of three methods in haematology. Identify key learning points for your future practice.

 

• Become familiar with the laboratory quality management system and perform examination and other audits as part of the laboratory accreditation process (applies to all specialist modules).